Fixing Health: A Gleaner special project
Today, The Gleaner begins its ‘Fixing Health’ series – a special project presented in association with our partners – Dr Alfred Dawes, president of the Jamaica Medical Doctors Association; Dr Shane Alexis, president of the Medical Association of Jamaica; and Janet Farr, president of the Nurses Association of Jamaica. Over the next few months, our ‘Fixing Health’ partners will delve into critical issues affecting Jamaica’s public-health sector; examine and analyse those challenges; conduct a SWOT analysis of the sector; and put forward viable, sustainable solutions and recommendations to resolve the problems and bring the sector on par with acceptable standards. Each week, look out for thought-provoking pieces from the experts. Email your feedback to: email@example.com.
Sector suffering from ill health
JAMAICA’S PUBLIC-HEALTH sector has undergone many phases over time. It has been well recognised that there is value in creating a healthy nation if we are to transform our society. Health must play a critical role in restructuring the social landscape of our country.
The World Health Organization’s philosophy recognises health as a fundamental right of every citizen. The Minister of Health, Dr Fenton Ferguson, has declared that the Government is keen on providing universal access to health through quality primary and secondary care.
There are currently 330 health centres and 24 hospitals, along with the University Hospital of the West Indies, which is the only tertiary institution providing specialist services. There are also 10 private hospitals and 495 pharmacies. All these institutions provide service for a population of 2.7 million people.
In Jamaica’s Health Sector Plan, 2009-2030, a framework was developed by a national task force, civil society, state agencies, ministries, non-governmental ministries, non-governmental organisations, independent development partners and other stakeholders.
They had several discussions and consultations on how they would achieve Vision 2030 for health in Jamaica. A detailed SWOT analysis was prepared as they identified the strengths, weaknesses, opportunities and threats.
There is obviously a need again to ‘fix health’ as, clearly, the system needs review as it is still suffering from ‘ill health’. We must include the professionals and users of the system, doctors, nurses and other professionals to assist in finding the correct treatment which will cure this ‘ill health’.
We must begin by doing our own SWOT analysis.
SWOT analysis of the Jamaican health sector
Qualified health professionals
Highly skilled clinical staff
Wide range of specialist services
Poor customer service
Longer waiting time
Underemployment of skilled professionals
Limited financial resources
Inappropriate deployment of staff
Lack of accountability
Lack of retention strategies
Abolition of posts
Problems need fixing
One of our critical problems is that the entrusted administrators within the present system do not cash in on the wealth of experience that we have obtained collectively, through our diversity of training as health-care professionals. There is a serious underemployment of staff – nurses, doctors and other support staff. There needs to be better coverage in terms of nurse-patient ratio.
The 1973 cadre for nurses, which still exists today, needs to be addressed with much urgency. This has been complicated with the increases in services offered, whereby facilities’ patient loads have increased but the cadre remained the same.
There must be an increase in employment to address the client-to-staff ratio, particularly nursing, to keep with international standards, in particular best practices and evidenced-based practice.
The Canadian system of four patients to one nurse, with support staff, and taking in consideration patient acuity, can be utilised.
Urgent attention should be given, as the patient ratio has increased significantly with the removal of user fees.
What exists now is a general shortage of health-care providers in key areas of health-service delivery – nurses, doctors – not to mention the high attrition rate of skilled personnel, coupled with the growing number of unemployed qualified health professionals.
There is also inappropriate deployment of staff – staff placed in areas in which their skills are under-utilised. There needs to be a revision of decentralisation to minimise duplication of duties and the time frame to complete tasks due to increased red tape to get issues resolved, or to get supplies.
The public-health sector is suffering from grossly inadequate funding, hence a lack of resources, non-functional equipment, health professionals left with low morale, and disgruntled clients. There needs to be a better forecasting and allocation of the needed resources, which would address the continual lack of basic resources such as cotton, gloves, gauze etc.
Poor remuneration in the health sector, not on par with our counterparts in other countries, has resulted in a brain drain, as health professionals seek greener pastures.
With the influx of migration of senior nursing personnel, the health-care facilities have been negatively impacted as there is a lack of experienced nurses to mentor those through the transition from novice to expert. This has implication for practice and subsequent care delivery.
The sector is plagued with weak leadership and management, hence poor/non-existent accountability due to increased nepotism and underqualified mangers, i.e., persons non-familiar with health-services management.
In comparison to other public-sector workers, health is the least recognised, locally and nationally. There needs to be greater recognition of health-professionals at the national level.
Though money cannot compensate for life, there also needs to be an incentive for health care workers in volatile areas and units.
Efforts should be made to improve the working condition and the physical infrastructure to include adequate lunch areas and restroom facilities for staff. The dilapidated environments in which caregivers operate are often demotivating.
Overcrowding of wards with an increase in bed spaces make the job more difficult, as privacy becomes a challenge, procedures are not efficiently performed, and the dignity of both the patient and staff are compromised. This places both the patient and staff at risk.
There must be the political will to increase the budgetary allocation to the health sector to 25 per cent of GDP. With the increase in chronic non-communicable diseases, there needs to be greater emphasis on preventive medicine through health promotion and training, to include primary health care in order to minimise lifestyle diseases.
Critical to all this, there is the need for greater collaboration of all stakeholders in decision making.
The primary driving forces that will change the Jamaican health-care system are:
1. Quality improvement
2. Customer satisfaction
3. Improvement in working conditions
4. Review of procurement policies.
The health of the population is equal to the wealth of the nation.
- Janet Farr is president of the Nurses’ Association of Jamaica.